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Medical Center
at Ithaca
Cayuga Medical Center Winter 2013
Cayuga Medical Center
Medical Center
at Ithaca
The News Magazine of
Cayuga Medical Center at Ithaca
Winter 2013
Senior Leadership Team
John Rudd
President and CEO
John Collett
Chief Operating Officer
Lloyd Darlow, MD
Vice President
Clinical Integration
Ellen Dugan
Vice President
Service Lines
Aids Ride for Life 2010
David Evelyn, MD
Vice President
Medical Affairs
Susan Nohelty, RN
Vice President
Patient Services
Alan Pedersen
Vice President
Human Resources
John W. Turner
Vice President
Public Relations
Tony Votaw
Vice President and
Chief Information Officer
Published by the
Office of Public Relations
John W. Turner
Vice President
Elizabeth Heath
Public Relations Specialist
Carol Grassi
Public Relations Specialist
Tanya Roberts
Administrative Assistant
Writing and Project Management
Julia C. Bonney
Principal Photography
Dede Hatch
Terry Marcus Design
Health Visions
Cayuga Medical Center
101 Dates Drive
Ithaca, New York 14850
(607) 274-4011
A discussion with our new president and CEO, John Rudd
6 Born to Run
Marathon track star Lizzy Jewiss shines with the help of the
Endurance Sports Performance Lab
8 A Tale of Two Thumbs
Local hand care gets two thumbs up from Nancy Eischen
Page 6
12 Fighting Back against Heart Attack
Shawn Bell, young husband and father, tells his story
16 Still Cookin’!
Local chef Kristof Ostlund goes “diving” to heal his wounds
20 Navigating the Local Health-Care System
Finding your way with the help of friendly experts
24 Bringing It All Together through Clinical Integration
To improve physical health and fiscal health
28 Cayuga Medical Center Updates
29 House Calls: David Monacelli, MD
Reconstructive surgery following mastectomy
Page 8
In this issue of Health Visions we are pleased to welcome president and CEO John Rudd,
who assumed his new role on January 1, 2013. He has been a member of the
Cayuga Medical Center family for the past seventeen years. We are proud of his many
accomplishments and look forward to continued growth under his skillful leadership.
ohn Rudd was no stranger to Ithaca when
he m0ved here with his young family in
1996 to become the medical center’s chief
financial officer under president and CEO
Bonnie Howell. Having lived first near Corning and then Syracuse, John came to love
this region from many family boating trips
and then bicycle trips around the Finger
Lakes as a teenager. Among the attractions of
Ithaca were the numerous outdoor activities
available here, including sailing on beautiful
Cayuga Lake. His passion for sailing and
cycling continues to this day: he sails out of
the Ithaca Yacht Club and rides regularly with
a group of friends from the medical center
and the community. He rode in the first AIDS
Ride for Life fourteen years ago and has participated in many subsequent rides.
Rudd and his wife, Beverly Chin, have
two children, Kirstin and Alec. Beverly
works for the Tompkins County Health
Planning Council, a program of the Human
Services Coalition. She is the Health Planning Council access coordinator and has
been active in the development of important
local health-care initiatives, such as Urgent
Rx. Kirstin, a recent Bucknell University
graduate in neuroscience, is working as
a research assistant at Harvard Medical
School. Alec is completing his senior year
at Rensselaer Polytechnic Institute (RPI),
majoring in mechanical engineering with a
special interest in robotics.
Health Visions sat down to talk with John
Rudd in late December.
When you address employee forums and
community groups you inevitably refer
to the medical center’s core values. Can
you talk about how these values inform
your approach as president and CEO?
Our five core values (our people, customer service, clinical quality and patient
safety, fiscal integrity, our community)
help us maintain the balanced approach
we need to achieve our mission, which
is to deliver the highest-quality health
care in partnership with our community,
one person at a time. In our day-today work, and as we plan for the
future, our programs and services
must pass the litmus test of supporting
these core values. 1
While all five core values are
critical, first and foremost must
be clinical quality and patient
safety. This value is the bedrock
that ensures our patients are
at the center of everything we
do. We are only able to provide patient-centered care by
supporting our people. This
incredible team of staff, physicians, and volunteers makes
all the difference in the care we
provide. Our focus on customer
service allows us to ensure that
Members of the administrative team at Cayuga Medical Center make rounds every week to connect with
everyone we serve has the best
employees and physicians. Rudd speaks with Carol Olcott, RN, in the Same-day Surgery Center.
possible experience as we strive
to meet our mission. Our commitment to fiscal integrity drives our ability
that our employees and physicians care
First and most important I want to say that
to meet the needs of the community and
deeply about the quality of their work and the our medical staff is phenomenal. Before
develop new services, because without an
patient experience. It’s my job to see that we
coming to Cayuga Medical Center I worked
eye toward sound financial management our
support their efforts in every way we can.
as a consultant in health care for many
work would be unsustainable. And finally,
One of the keys to improving both the quality
years and interviewed numerous medical
our commitment to community partnerships
of care and patient safety is getting timely,
staff members at other hospitals. We have
is essential because health care is a local
honest feedback when staff members pick up
physicians coming out of the top medical
concern. Our strong community connecon situations that could be unsafe or process- schools in the country. Their training and
tions, our involvement on the boards of local
es that need to be modified. We are working
the high level of care they provide are very
organizations—these help to ensure that this
to foster an atmosphere in which everyone
medical center is providing access to the
is comfortable reporting these observations,
Over the years I’ve played a principal role
care needed by our community.
because this is how we will be able to conwith our physician-hospital organization,
tinually improve.
Cayuga Area Plan, and with the Cayuga Area
Patient safety and clinical quality have
There are many standardized measures of
Physicians Alliance, which includes most of
been the medical center’s top priorities.
quality and patient safety in the health-care
our medical staff members. I’ve collaborated
How will you encourage the continued
field. We do very well within the particular
with most of the physicians on our medical
focus on these issues?
set of parameters used by Consumer Reports,
staff on various special projects, such as the
as reported in their August 2012 issue, which
development of our oncology program, the
We have an established structure in place
identified Cayuga Medical Center as the safest growth of local cardiology services, and our
to help us identify safety issues, develop
hospital in New York State. However, it was
continued expansion in orthopedics, sports
processes to resolve these issues, measure
clear from that report that we—and every
medicine, and athletic training. It’s been
our progress, and then cycle back around to
other hospital in the country—have signifivery gratifying to work with our doctors in
reassess. This improvement cycle is continucant room for improvement and we are workthe design and building of our new imaging
al and it’s making a positive difference here.
ing hard toward this goal.
department, laboratory, and surgical serWe have a very active Quality and Patient
vices department. We’re working right now
Safety Committee that includes physicians,
You’ve worked very closely with the
on our new maternity unit, which will open
staff, and members of our board of directors;
medical staff during the past seventeen
in about a year.
our board is very focused on quality care
years. How would you characterize the
Cayuga Medical Center has a mixed
and patient safety, which is wonderful.
relationship between the medical staff
model in terms of our formal relationships
I know from my own experience here
and the hospital?
with area physicians. Some members of our
2 WINTER 2013 / Health Visions
Rudd has played an integral role in expanding imaging services to meet the needs of the community. In the Imaging Services Department he chats
with Mike Fell, RT (R) CT, and Mike Reynolds, RT (R) CT, who are both radiologic technologists certified in CT scanning.
medical staff are employed by the medical
center and some physicians are affiliated
with the medical center through Cayuga
Medical Associates. However, the majority
of physicians on our medical staff are still
in independent practices, and we work hard
to support them because they are essential as we move forward with our strategic
initiatives. I think this model is a healthy
mix. My own relationships with individual
doctors have been established over the
years through formal mechanisms, including special projects and many committees
including our Physician Council, as well as
through informal channels, such as cycling,
school sports, and family activities. I value
all of these relationships and look forward
to making them even stronger.
Please describe your personal philosophy
of leadership.
I believe good leadership is about listening
to and serving our employees and physicians in order to help them to do the best
job they can. If we are going to promote
an environment in which clinical quality
and patient safety are openly discussed,
analyzed, and improved, I need to hear from
employees and physicians about the tools
and support they need to do their jobs. My
role as a leader is to serve our caregivers and
enable them to be excellent clinicians and
patient advocates. I also want to hear from
the community we serve. I want as much
feedback as possible on our patients’ experiences and how the community believes we
can improve in providing these services.
care-delivery network with accepted, shared
standards for measuring our success. This
will help us simultaneously address both
the quality and the cost of care.
Health care reform is upon us because the
system as we know it is unsustainable.
Please talk about Cayuga Medical Center’s
proactive response to this sea change.
With a workforce of 1,300 employees,
Cayuga Medical Center is the fourth largest
employer in Tompkins County. As the
heart of the local health-care network, we
have a responsibility to provide comprehensive, high-quality care and to meet the
health-care needs of area businesses’
employees. Over the years we have teamed
up with employers to address acute care
needs as well as prevention and healthy
living initiatives, such as tobacco cessation
programs and stress management classes
through the Cayuga Center for Healthy
Living. Our shared goal is to create a
healthier community.
We must go beyond health care in our
local relationships, however. The medical
center has an additional commitment to
work collaboratively on important community initiatives with other employers and
human service organizations. One of the
We have been working on clinical integration
in partnership with our physicians for the
past three years. There is a very good article
in this issue of Health Visions that explains in
more depth what clinical integration is and
why it’s so important. Our goal, as we move
into the future, is to deliver the best possible
health care for patients in our community
and to provide this care in the most costefficient way we can. Clinical integration is
a very sound way to improve the quality and
cost efficiency of the care we provide in partnership with our physicians while preserving our vibrant local health-care network.
By working together, the medical center
and physicians are developing a stronger
How do you see Cayuga Medical Center’s
role as a major employer and community
leader? 3
The morning meeting in the Intensive Coronary Care Unit with Carrie Westlake, RRT; James Morton, RRT; John Rudd; Dr. Peter Hannon, ICCU medical
director; Shawn Newvine, RN, ICCU director; Christine Monacelli, RN; and hospital chaplain Tim Dean.
areas in which we are especially interested
is protecting our environment. I earned my
B.S. degree in biology with a special focus
in environmental science, so this particular
topic is near and dear to my heart. I was
an early member of the Tompkins County
Climate Protection Initiative, joining forces
with representatives from all of the major
local employers. We want to support a
sustainable community here, which means
that we engage in environmentally responsible business practices, including how we
construct new buildings and how we use,
reuse, and recycle key resources.
I also firmly believe that we, as community leaders, need to give back to our
community. One way of doing this is
through service on local boards. The list
of service by Cayuga Medical Center employees is quite impressive. Over the years
I personally have served on the boards of
a number of organizations, including the
United Way of Tompkins County, Challenge
Industries, Kendal at Ithaca, Beechtree
Care Center, Franziska Racker Centers,
Tompkins County Area Development
(TCAD), Opportunities, Alternatives, and
Resources of Tompkins County (OAR),
and the Tompkins County Chamber of
4 WINTER 2013 / Health Visions
Cayuga Medical Center has recently
expanded services into Schuyler County.
Talk about your progress and your plans
for the future.
Affiliations with world-class health-care
providers have provided easy local access to
advanced care in cardiology and oncology.
How are these affiliations working?
Cayuga Medical Center tries to meet
regional health-care needs across our service area, which stretches from Cortland
to Montour Falls and Watkins Glen, south
toward Elmira and Binghamton, and
north toward Geneva and Auburn.
Over the past couple of years we have
formalized our relationship with Schuyler
Hospital and developed a collaborative
partnership with them. Together we are
identifying ways to make sure that care
that can be provided in their community
is being provided there. To that end, we
established Cayuga Schuyler Orthopedic
Services to bring state-of-the-art orthopedic and sports medicine care to
that community. We are continuing to
assess this relationship, which is proving to be very positive. I believe a natural
connection and a cultural affinity exist
between Tompkins County and Schuyler
County that make it easy for us to work
together. It’s also a beautiful and easy
drive to Watkins Glen—I highly recommend it!
Our relationships with those institutions
have benefited our community dramatically
by allowing us to provide an advanced level
of care that would have been impossible
otherwise. Eight years ago we were able to
launch a very sophisticated radiation oncology program here, thanks to our relationship
with Roswell Park Cancer Institute. Opening
one of the first stand-alone cardiac catheterization programs here twelve years ago and
then transitioning to interventional cardiac
care was only possible with the assistance
of a world-class provider like the Rochester
Heart Institute. Our laboratory is expanding
local capabilities through our affiliation with
Mayo Medical Laboratories.
I believe we can build on these important
relationships and continue to develop new
local services right here in our community
with the help of these organizations. Most
recently we entered a collaborative relationship in orthopedics with University of
Rochester—Strong Memorial Hospital, which
supports our expanding local Orthopedics
and Sports Medicine Program. All of our
Jim Durkee, executive chef in the Department of Nutrition and Dining, has played a significant role in
developing the tasty, healthy menu choices at Cayuga Medical Center.
collaborative partners are organizations that
support the mission of local health care;
however, when our patients need something
we don’t provide locally we can expect a
very smooth transition of care to a higher
level through our established connections.
My goal is to see that our community has
access to world-class care through Cayuga
Medical Center and its affiliate partners.
In addition to clinical affiliations we have
important academic affiliations. How do
these benefit the community?
Better medicine is all about raising the bar,
and this is accomplished through education. Our affiliations with Cornell University,
Ithaca College, Tompkins Cortland Community College, and others have served to raise
the bar for us. We get wonderful feedback
from doctors in training who have been
through the Weill Cornell Medical College
teaching rotation at Cayuga Medical Center.
These physicians in training spend time at
the medical center but also with our community physicians, where they get a more
“real world” view of care in a community
setting. These positive experiences during
medical school and residency would not be
possible without the incredible commitment
and support of so many of our physicians.
This program also helps our physician recruitment efforts as our reputation becomes
more widely touted at places like Weill
Cornell Medical School.
Another great example of raising the bar
through an academic affiliation is in our
Department of Physical Therapy. Our
relationship with Ithaca College and our
orthopedic physical therapy residency program are drawing highly trained practitioners to work here because they know we are
affiliated with a strong teaching program.
As we continue to develop other academic
affiliations and strengthen those we already
have, our medical center’s reputation is
enhanced. This has a positive impact on
the quality of providers who want to join us
and ultimately affects the quality of care we
provide. Just the other day I read a phenomenal letter from a patient about Colleen
Masterson, DPT, who was our first orthopedic physical therapy residency graduate and
who now works for us. The patient praised
Colleen for her clinical skills and for the
compassion she showed as a provider.
You are personally committed to helping
Tompkins County become a healthier
community. Please tell us more.
Diabetes and obesity
are at epidemic levels
and predicted to get
worse. If we don’t
recognize this dangerous trend and strive to
make a difference we
aren’t doing our jobs as
health-care providers.
I believe this hospital
has an obligation to
focus on how we can
improve the health of
our community, and
prevention is a critical
part of this. Historically
the health-care industry
has concentrated far too much on acute
care. What we need now is a balanced
approach that includes services to promote health and treat the chronically ill,
as well as treat acute injury and illness.
We are, after all, a health-care organization and that implies taking care of
people’s health. This includes helping
them to stay healthy and helping them
to more effectively manage their health
should they become chronically ill.
It is through efforts such as the programs
offered at the Island Health Center and
the Cayuga Center for Healthy Living
that I believe we can make a difference.
Any final words?
In closing I just want to say that I am
honored and proud to be a member
of the Cayuga Medical Center family.
Cayuga Medical Center has been and
will continue to be an important part
of my life. I am committed to the extraordinary people who work here and
to the community we all serve, as we, in
partnership, strive to provide the highest
quality of care for our community. I am
looking forward to the next part of our
journey together.
Medical Center
at Ithaca 5
Born to Run!
Lithesome and blue-eyed with a ponytail that swings wildly as she runs,
Lizzy Jewiss is a driven young athlete. In seventh grade she decided to
take up running to stay in shape for soccer.
Marathon Track Star Lizzy Jewiss
hen the track
coach saw Lizzy
working out, he approached her about
going out for the track
team. As an eighthgrader she joined
Marathon’s varsity
cross-country team and
made it to the New York
State Championships.
Jewiss, now a senior, has
competed in the state
finals every year since
eighth grade and has
been ranked in the top
ten in cross-country for
class D schools in New
York State.
In February 2011,
when Jewiss was at the
peak of her training, she
decided to maximize
her performance over
the next few months.
“I wanted to prepare
for outdoor track in my
junior year,” she says.
“I wanted to hit all of
the record times.” Her
coach and Marathon
High School athletics
director, Todd James,
suggested that she make
an appointment with
Dr. Andrew Getzin at
the Endurance Sports
Performance Lab at
Cayuga Medical Center
Sports Medicine and
Athletic Performance. As
it turned out Jewiss and
Getzin were old friends.
She had seen him for a
number of injuries over
the years, among them
a broken wrist from
slipping on the gym
floor, pulled abdominal
muscles from a game of
floor hockey, and tendon
separation in her foot
from a nasty encounter
with a recliner chair. Most
of these injuries occurred
just weeks before major
track meets but with
Getzin’s help this determined runner inevitably
bounced back in time to
Jewiss followed her
coach’s suggestion and
went to the Endurance
Sports Performance Lab.
She subsequently went
on to break all of the
women’s indoor track
records at Marathon High
School for distances from
400 to 3,000 meters.
Getting the data
While Jewiss ran on the
treadmill, Getzin and his
colleagues collected data
on her heart rate and
oxygen uptake levels during VO2-max (maximal
oxygen uptake) testing.
When used properly this
information provides
excellent parameters for
fitness and is helpful for
endurance athletes who
want to improve their
performance. Jewiss’s
treadmill test provided
some interesting findings.
A training regimen
for someone like Jewiss
involves a rotating schedule of days designated for
easy runs, long-distance
runs, and short runs. “I
learned that on the days
I was doing my easy
runs, I was running way
too fast,” says Jewiss.
“So Dr. Getzin told me
to wear a heart monitor
during training to guide
the intensity and pace of
my running. By slowing
down during my easy
runs I was able to work
harder on the days I had
my hard, fast runs because I had less recovery
from the day before.”
“Lizzy learned that you
can still make positive
gains on days when you
aren’t putting extreme
stress on your body,”
Getzin observes. “You
have to get enough rest to
be able to run hard when
you want to run hard.
This is a training mistake
a lot of athletes make.”
Getzin recently had the
seventeen-year-old Marathon High School senior
running on the treadmill in the performance
lab. Jewiss is currently
recovering from a stress
fracture in her leg that
occurred during the 2012
outdoor track season. “I
ignored the injury because
I didn’t want to stop running,” she confesses with
a guilty smile. “When I
finally took care of it I was
out for three weeks, so I
water trained. I want Dr.
Getzin to retest me this
coming spring to get a better sense of my fitness and
how well I’ve recovered
from the stress fracture.”
“The challenge in
training,” Getzin explains,
Dr. Andrew Getzin and Lizzy Jewiss in the Endurance
Sports Performance Lab
“is that you walk a
tightrope between training and over-training.
For an athlete the goal is
to increase your training stress to a sufficient
level that will allow your
body to successfully
adapt to the new load
without injury. In the
performance lab we help
athletes maximize their
performance by providing
them with good data to
improve their outcomes.
Lizzy Jewiss is wonderful
to work with,” he adds.
“She is a high-level,
highly motivated athlete.
She’s also had excellent
Dr. Andrew Getzin, who played football during college and then rugby, is a
competitive athlete, earning All-American
status with the USA Triathlon for the past
four years. In October 2012, he competed
in the Ironman World Championship in
Kona, Hawaii, having qualified at the Lake
Placid Ironman. Dr. Getzin is the clinical
director of Cayuga Medical Center Sports
Medicine and Athletic Performance and
is codirector of the annual Cayuga Lake
“One of the things
that’s most helpful about
Dr. Getzin is that he’s an
athlete and he understands that getting back
to running quickly is very
important to me,” says
Jewiss. She remembers
when she broke her wrist
there were concerns raised
that maybe she shouldn’t
run until it was healed.
“But when I saw Dr. Getzin,
he said I could run with
my wrist in a cast; I just
had to be cautious not to
fall and reinjure myself. He
understood that I needed
to run!” Indeed, it seems
running is what Lizzy
Jewiss was born to do.
Medical Center
at Ithaca
Triathlon Sports Medicine Conference. He
is the head team physician for Ithaca
College, TC3, and Finger Lakes Gymnastics Academy and regularly provides
medical coverage for national sporting
events, most recently at the NYC Ironman.
For more information on the Endurance
Sports Performance Lab visit the
Cayuga Medical Center Web site or
call (607) 252-3580. 7
A Tale of
Two Thumbs
he hand is a complex
structure with eight bones in
the wrist, five bones that form
the palm, twelve bones in the
fingers, and two bones in the
thumb. These bones, some of
which are pretty tiny, are the
framework for a complicated network of fascia, joints, muscles,
tendons, ligaments, and nerves,
all of which are covered in highly
sensitive skin. If you stop to consider the range of movement and
strength in your hands­—and the
nearly infinite number of tasks
for which they are so exquisitely
designed—it’s truly amazing. And
yet many of us take our hands
for granted.
8 WINTER 2013 / Health Visions
ancy Eischen is a labor arbitrator and mediator who started
her career at age forty, after raising three sons and then earning a
master’s degree from Cornell University’s ILR School. Like all of us she
inherited many traits from her parents, among them beautiful silver
hair from her dad and osteoarthritis from her mom. Now, at age sixtyone, Eischen says her only health complaint is osteoarthritis. She had
carpal tunnel surgery in both of her wrists thirty years ago and now
her knees are giving her trouble. Nevertheless, she leads a very busy
life with her husband, Dana (a nationally known labor arbitrator),
three black Labs, and a twelve-week-old bloodhound puppy named
For well over a decade Eischen suffered from severe osteoarthritis
in the basal joints of her thumbs. This small joint at the base of the
thumb and adjacent to the wrist enables human beings to grip and
grasp. In people like Eischen with advanced osteoarthritis, the cartilage between the bones in the affected joints wears away and, without
this cushion, the bones grind together. Eischen describes the sensation in her thumbs as a combination of constant aching and razorsharp pain that radiated up into her neck. “I would lean over to pick
up something and my eyes would fill involuntarily because it hurt so
much,” she says. “My right hand was especially frightening because at
times it was so numb I’d drop things and not even feel my hand letting
go.” It became impossible for her to hold her grandchildren safely.
“What really makes my story interesting is that I had hand
surgery on each of my thumbs, nine years apart, and I got two
different results,” says Eischen. “After my first surgery I didn’t do
what I should have done. I didn’t do the exercises I was told to
do by my surgeon and my physical therapist, and I didn’t take my
pain pills. I was lazy. As a result I am still not able to grasp very
well with my right hand.”
In May 2012, Eischen decided the time had come to have surgery on her other hand. She went into the process with a completely different attitude. “I realized I didn’t do it right the first
time around. I went back to Dr. Stephanie Roach, who is a very
talented hand surgeon and a lovely person,” says Eischen. “I have
a great deal of respect for her and can’t say enough good things
about her. She was very honest with me about the fact that recovery
from hand surgery is painful but if I did what was required of me,
I would get the result she said I would get.”
Eischen underwent arthroplasty to remove part of the bone
at the base of her thumb. Dr. Roach used the adjacent tendon in
the forearm to rebuild a ligament for the joint and fill the joint
space with soft tissue. This surgery effectively eliminated pain
from the bone-on-bone grinding and with time it would restore
movement in Eischen’s thumb.
A few days later, Eischen went for the first of her postoperative
physical therapy sessions with certified hand therapist Jeff Humphrey, MPT. He fitted her with a custom-made brace and they began
physical therapy. “Jeff has a professional, laid-back manner and a
quiet, calm demeanor,” says Eischen. “He and Dr. Roach made me
want to do the work.” Eischen underwent physical therapy at Cayuga
Medical Center’s Brentwood office, which is adjacent to the Convenient Care Campus. “I looked forward to seeing them. Everyone there
is very competent and professional.
“I did what Jeff told me to do. I did my exercises at home and took
my pain medications and I have 100 percent recovery,” says Eischen.
“My hands do get tired—between the computer and cooking, I overdo
it,” she adds. “But I have no qualms about picking up my beautiful
six-month-old grandchild.
“It’s a miracle surgery,” Eischen says. “If you want to get the best
hand surgery available in central New York and top-notch professional physical therapy, go to Cayuga Medical Center. I’ve had three
kids play football so I’ve seen a lot of broken bones and been to a
lot of orthopedic surgeons. This is the place to go. The demeanor
and professionalism of Dr. Roach and Cayuga Medical Center really
worked for me.” 9
Local Hand Care
Two Thumbs Up!
“We can fix these problems!”
Dr. Stephanie Roach completed her fellowship training in hand surgery in 1999 but she
has loved this subspecialty since early in her
orthopedic residency. “I am fascinated by
the anatomy of the hand,” she says. “Most
orthopedic residents don’t like hand surgery
but I actually didn’t mind being called out
in the middle of the night to take care of a
patient with a hand injury. These days I’m
doing a lot of this type of surgery; I enjoy it
and it really helps people.”
Given the intricacy and range of motion
of the hand and wrist—and how hard they
work day in and day out—there is a long list
of operations hand surgeons perform on a
regular basis. “I do a lot of surgery for carpal
tunnel release, trigger finger release, and
finger fractures,” says Roach. “I treat a lot of
arthritis, especially in the thumb, and I also
do joint replacement in the fingers to treat
both osteoarthritis and rheumatoid arthri-
tis. Wrist fractures often require surgery,”
she adds. “These can be tough because
they’re so variable and the breaks come in a
lot of different patterns. Patients with wrist
fractures often need physical therapy after
surgery and casting.
“Our hand physical therapists are very
important for specific problems,” Roach
continues. “We couldn’t do tendon repairs
without them. They create braces that protect
the repair while it’s healing and then they
help the patient regain movement after the
healing is completed.” Patients undergoing
joint reconstruction for thumb arthritis have
similar needs. Finger fractures and wrist fractures typically leave people with stiff joints,
weakness, and limited range of motion. “Our
hand therapists are very knowledgeable,”
says Roach. “I get really good feedback from
my patients on their care.”
If you have a hand problem, Dr. Stephanie
Roach would rather see you sooner than
later. “Lots of people ignore hand problems
for a long time,” she says, “but it’s really
worthwhile getting it checked out. If you’ve
got troubling symptoms, like tingling, numbness, or pain in your hands and fingers you
might have a pinched nerve in your wrist.
You want it looked into before permanent
damage occurs. We can fix these problems!”
Th e H a n d y W o r k o f H a n d Th e r a p i s t s
Due to the hand’s intricate anatomy, hand
care is a recognized subspecialty among
both orthopedic surgeons and physical
therapists. Comprehensive hand care is
provided locally by two highly skilled orthopedic surgeons with fellowship training in
hands and upper extremities, as well as by
two experienced physical therapists who are
board certified in hand therapy.
Jeff Humphrey, PT, MPT, CHT, CEAS,
is the physical therapy supervisor at the
Brentwood office of Cayuga Medical Center’s
Department of Physical Therapy. He has
been treating patients with hand injuries for
many years, having become a certified hand
therapist in 2004. “People sometimes feel
Jeff Humphrey, PT, MPT, CHT, CEAS
10 WINTER 2013 / Health Visions
that their hands are less important than
their feet or legs because they don’t need
their hands to walk around,” says Humphrey. “But if you’ve ever injured your
hands, you quickly understand that you use
them for everything you do all day long—
from bathing, dressing, and eating to work
activities, hobbies, and sports. Your hands
are very important tools.”
Humphrey is one of two board-certified
hand therapists on staff. His colleague,
Mark Malys, PT, CHT, sees patients in
the Department of Physical Therapy at
the Island Health Center. A third physical
therapist at Cayuga Medical Center,
Christine Feely, PT, MPT, is in the process
of pursuing hand therapy certification.
As certified hand therapists, Humphrey
and Malys help people recover the function
in their hands, wrists, and elbows following
traumatic injuries such as broken fingers,
wrists, and elbows, burns, and the loss of
fingers. They also see many patients with
overuse injuries, such as tendonitis and
carpal tunnel syndrome, and chronic conditions such as arthritis. Many of their patients
require only physical therapy to recover from
their injuries and regain function in their
hands and wrists. Other patients have had
hand surgery and are referred by their hand
surgeon for postsurgical physical therapy.
Malys, who has been certified in hand
therapy since 1996, explains that the position of the hand, fingers, and thumb is
crucial following surgery because contractures can occur that make it difficult to
achieve full range of motion again. One of
the jobs of a hand therapist is to fabricate
custom-made splints for postoperative
patients to protect the surgical site. This is
meticulous work and requires a solid knowledge of the hand’s anatomy, as well as the
Stephanie Roach, MD
Orthopedic Services of Cayuga Medical Associates
1301 Trumansburg Road, Suite R
Ithaca, NY 14850 | (607) 272-7000
Medical School:
State University of New York (SUNY) Upstate
Medical University (Syracuse, NY)
Internship and Residency:
SUNY Upstate University Hospital (Syracuse, NY) –
Orthopedic Surgery
Fellowship: Allegheny General Hospital
(Pittsburgh, PA) – Hand and Upper Extremity
Board Certification: Hand Surgery;
Orthopedic Surgery
Honors: Doctor of Medicine cum Laude; Alpha
Omega Alpha Medical Honor Society; Phi Beta
Kappa Honor Society
Areas of special interest: Carpal tunnel release; trigger finger release; finger fractures; joint
replacement/finger and thumb; wrist fractures
Kim Carney Young, MD
Orthopedic Services of Cayuga Medical Associates
1301 Trumansburg Road, Suite R
Ithaca, NY 14850 | (607) 272-7000
Mark Malys, PT, CHT
patient’s specific surgical procedure.
Postsurgical rehabilitation involves controlled, safe movements of the hand while
it heals. Collagen is the body’s natural glue,
Malys explains, and it is produced during
the healing process, forming scars. “Physical
therapy is so crucial following hand surgery
because the tendons, ligaments, and nerves
in the hand are small and prone to developing scar tissue and adhesions, which limit
range of motion,” he says. “We can remodel
the scar tissue by moving the hand in a
controlled way, gently gliding the tendons
within the hand to prevent stiffness. Patients
are often nervous and in pain and may not
want to move their hands at all,” he adds,
“so we devote a lot of time to patient education to help them overcome their fears.
“We have a good rapport with our hand
doctors,” Malys continues. “They
send us detailed referrals explaining
what procedure was performed and
what direction we should take with
that particular patient. Through our
electronic medical records system we
can access the operative reports and
read the surgeon’s notes, which often
saves us a phone call. But if we have
any particular concerns or questions,
Dr. Carney Young and Dr. Roach are
always willing to discuss them over
the phone.
“The therapeutic process for hand
surgery is a triad,” Malys concludes.
“You need a good hand surgeon, a
good hand therapist, and a patient
who is committed to doing the work it
takes to heal well.”
Medical Center
at Ithaca
Medical School: University of Buffalo School of
Medicine (Buffalo, NY)
Internship and Residency: University of
Rochester Medical Center (Rochester, NY) –
Orthopedic Surgery
Fellowship: Hospital for Special Surgery
(New York, NY) – Hand and Upper Extremity
Board Certification: Orthopedic Surgery
Honors: New York Society for Surgery of the
Hand (NYSSH) 2nd Place Research Symposium;
“Strong Star” patient-nominated award for excellent patient care; Alpha Omega Alpha Medical
Honor Society; Dean’s Letter of Commendation
throughout medical school; American Society for
Surgery of the Hand (ASSH) Young Leader 2011;
ASSH Information Technology Advisory Group
committee member
Areas of special interest: Joint replacement/
finger, thumb, wrist, and elbow; wrist arthroscopy;
post-traumatic reconstruction of hand and wrist;
treatment of complex trauma 11
Fighting Back
Aga i n s t H e a r t At tac k
It’s not hard to pick out Shawn Bell in the monitored cardiac exercise class at the Island
Health Center: he’s the thirty-nine-year-old guy in a baseball cap. Fit and young, the father
of two sons, six and eight years old, Bell is not a person who comes to mind when most of
us think about people who have had heart attacks.
pril 20, 2012, had been a fun day romping outside with the
kids and riding four-wheelers around their home in Venice, a small
town west of Moravia. The Bells and visiting friends ordered take-out
Chinese food and the evening wound down watching a movie on TV.
Andrea Bell, a cardiac nurse at Cayuga Medical Center, turned in at
10:00 p.m. because she was on emergency call that weekend for the
Cayuga Heart Institute.
Around 10:30 Shawn began to feel very strange. “I was uncomfortable and I stood up, sweating,” he recalls. “Then it felt like I had
about forty knives in my chest. I was thinking I had indigestion from
the take-out food.” He walked into the bedroom and crumpled to
his knees at the edge of the bed. “Andi [his wife] asked me what was
wrong and flipped on the light, and meanwhile I’m thinking I really
need some Rolaids!”
“Initially I thought he had a stomach bug, but as soon as he
clutched his chest my first instinct was to call 9-1-1,” says Andrea.
“We went into the bathroom because Shawn felt nauseous; he
started to pass out and I called his name. I dug an aspirin out of our
first aid kit under the sink (it wasn’t in the medicine cabinet because
we use ibuprofen in our house) and had him chew it. I don’t know
if I knew at that point that he was having a heart attack—I was in disbelief—but my training automatically kicked in and I knew what to
do. Then we walked out on to the porch to get cooler and wait for the
ambulance. Shawn turned to me and said, �Take care of the boys,’ ”
she remembers, tearing up.
Long Hill Fire Department arrived first, within a few minutes
of Andrea’s call, and Southern Cayuga Ambulance arrived quickly
thereafter. The crew put Shawn on a stretcher and told Andrea they
would meet her at a nearby hospital. She said, “No, I’ll see you in
Ithaca; I want you to take him to Cayuga Medical Center.”
The ambulance EMTs (emergency medical technicians) confirmed
that Shawn was having a heart attack. “It was really, really terrifying,” says Shawn. “It’s the worst pain I have ever experienced. I’ve
had two knee surgeries and busted fingers, but this was by far the
worst pain I’ve ever felt. I was also thinking about my family history,”
he adds. “Not many men on my father’s side lived to see sixty-five
because they all had heart issues. There’s a history of heart disease
on my mother’s side, too.”
When seconds count
When EMTs respond to a 9-1-1 call for a suspected heart attack,
they perform an electrocardiogram (EKG) right on the spot. When a
patient is suffering a major heart attack in which the coronary artery
is completely blocked, the EKG reading shows certain characteristic
changes. This change is called ST segment elevation. Among cardiac
care providers this is referred to as a STEMI heart attack. STEMI is
an acronym for ST segment elevated myocardial infarction and it is
serious business.
The Southern Cayuga Ambulance crew contacted the Emergency
Department from the road and a call immediately went out to the
Cayuga Heart Institute STEMI Team, which is a specially trained
group comprising an interventional cardiologist, cardiac care nurses,
and technicians. The STEMI Team is on call 24/7. Before Andrea
Bell drove to the Emergency Department that night, she called her
supervisor, Sharey Selover, RN, to tell her she was on the way to the
hospital and needed someone to cover on-call for her. Right after
Andrea hung up, she received a call on her cell phone summoning the STEMI team to the Cayuga Heart Institute to take care of an
incoming heart attack patient. She knew that patient was Shawn.
Interventional cardiologist Dr. Stephanie Goodwin arrived at
the Emergency Department within minutes of Shawn’s ambulance.
“STEMI heart attacks are the type of heart attack we have talked
about a lot in our community education programs,” says Goodwin.
“These are critical situations where we have to open up the artery as
quickly as possible. It turned out that Shawn’s right coronary artery
was 100 percent blocked. Another artery was 80 percent blocked and
a third was 50 percent blocked.”
Goodwin introduced herself to Shawn and started to explain 13
about opening his blocked artery with balloon angioplasty and a stent, but he told
her he knew about it already because his
wife worked in the cardiac cath lab. Goodwin turned around to see her colleague,
Andrea Bell, peering into the room. “It’s
tougher to take care of the spouse of someone you know, especially a young father
with kids,” Goodwin admits. “Kids really
need their fathers.” Shawn was whisked up
so I didn’t think twice about where I wanted
Shawn to go. I knew if he had a problem
they could fix, they would fix it. And if they
couldn’t fix it, they would stabilize him
quickly and safely. We are all held to a very
high standard here and I’m very confident in
this team.
“Shawn did get special treatment,” says
Andrea. “He got exactly the same special
treatment all of our patients get. I work
“Shawn did get special treatment. He got
exactly the same special treatment all of our
patients get.” Andrea Bell, RN
to the cardiac catheterization suite where
the team was already assembled, thanks
to the timely call from Southern Cayuga
Ambulance. Sandra Fuller, RN, director of
the Cayuga Heart Institute, had come in on
a moment’s notice to take over Andrea’s
on-call shift.
on the STEMI Team. We take care of the
patient and the family—and they did for me
exactly what I’ve done for others. We move
very quickly here and it was kind of surreal
watching it all happen from another perspective. Shawn’s care was just as fast and
efficient as the care here always is.”
Special treatment
Time is muscle!
Andrea Bell paced about the waiting room
at the Cayuga Heart Institute while the
team worked on her husband. “As soon as
the on-call team was here and Dr. Goodwin
got Shawn into the cath lab, I breathed a
sigh of relief,” says Andrea. “I knew he’d be
okay at that point.”
When asked about her decision to take
Shawn to Cayuga Medical Center instead of
a hospital that was closer, Andrea is very
clear about her rationale. “I didn’t know
if there was interventional care [at the
other hospital] but it wouldn’t have made
a difference in my decision. I’ve worked
closely with the team here. The whole staff
at the Cayuga Heart Institute is amazing,
14 WINTER 2013 / Health Visions
Cardiac care guidelines call for hospitals
to open a blocked coronary artery (using
catheters and devices such as balloon angioplasty and stents) within ninety minutes.
This window of time is called door-toballoon time. Shawn’s door-to balloon time
was thirty-five minutes, which means that
his blocked artery was open and life-saving
blood was flowing into his heart muscle just
thirty-five minutes after he came through
the Emergency Department doors. “When
we looked at his heart function the following day, it was near normal,” says Goodwin.
“This implies that there was not substantial
damage to his heart, which is our goal.”
On May 10, Shawn went back to the
Cayuga Heart Institute so Dr. Goodwin could
perform stenting on the heart artery with
an 80 percent blockage. On June 1, he
returned to his job as an engineering technician at Cargill Deicing Technologies. Two
weeks later he started eighteen weeks of
cardiac rehabilitation with the Cayuga
Center for Healthy Living at the Island
Health Center.
A new normal
The cardiac rehab program offered Shawn
five classes and he took all of them, covering
topics such as diet, stress relief and management, medications, exercise, and the impact
of family history on heart disease. “I wanted
to learn everything I could to prevent this
from happening again,” says Shawn, “and I
recommend that anyone with similar issues
take advantage of these classes. I learned
how to exercise properly in cardiac rehabilitation, where my heart is monitored. It’s
been an eye-opening experience for me.”
“Everything has changed in our house,”
says Andrea. “Our diet wasn’t horrible
before but we have completely changed
how we eat. Now we eat two fish meals a
week and much more vegetarian food. This
change is family-wide. Shawn is also on five
medications a day. Our kids ask at mealtime
if Daddy has taken his medicine.”
“Right after I got the first stent I felt
about ten years younger,” says Shawn. “I
feel excellent. I have more energy and can
do much more now without being winded.
I just didn’t realize how bad I had been
feeling; I wasn’t listening to what my body
was telling me. You know, when we think
of heart problems, we tend to think of
older people, who are overweight and who
smoke,” he adds. “But I’m a young, healthy,
active person. If this could happen to me, it
could happen to anyone.”
What you should know
“The interventional services at the Cayuga
Heart Institute are benefiting many people in the community—from people in their twenties
to those in their nineties.” Stephanie Goodwin, DO, FACC
heart–attack symptoms
Symptoms can occur in the center of the chest from the bottom of the ribs to the neck, and may also involve the throat, arms, jaw, and back between the shoulder blades.
Symptoms can vary. Some people experience a sensation of pressure, burning (similar to indigestion),
an ache, or a feeling of tightness. They often describe their symptoms as discomfort, rather than severe pain. Other people, like Shawn Bell, experience crushing chest pain.
The symptoms may be constant but can also fluctuate in intensity.
Symptoms may be accompanied
by shortness of breath, nausea, vomiting, sweating, light-headed-
ness or passing out.
Dr. Stephanie Goodwin, Cayuga Heart Institute at Cayuga Medical Center
Life-saving information
“There is no question that Andrea saved
Shawn’s life,” says Dr. Goodwin. “It’s very
important for people to understand that
her actions to get him to the hospital so
quickly saved him. And everything Shawn
has done to change his life subsequent to
learning he has heart disease will realize
long-term benefits for him. He’s been a great
patient in terms of recognizing the importance of risk modification and participating
in cardiac rehab. Risk factors can include
smoking, high blood pressure, high cholesterol, diabetes, obesity, lack of physical
activity, and family history. His health now
is excellent.”
According to Goodwin, while heart
attacks in people aged forty and younger are
not common, they do happen more often
than most people believe. “The vast majority
of cardiac patients we’ve managed here in
the urgent or emergency setting have been
on the younger side, under seventy-five
years old,” she says. “The interventional services at the Cayuga Heart
Institute are benefiting many people
in the community—from people in
their twenties to those in their nineties—and have made a substantial
difference in improving survival rates
and overall heart health.”
What’s the take-away message?
Know the signs of heart attack.
And even if you are not certain the
symptoms you are having are those
of a heart attack, call an ambulance
“I thought my care was awesome:
I had the best of everything. I couldn’t
have asked for a better hospital stay,”
says Shawn Bell. “If it weren’t for
Andi, Dr. Goodwin, the STEMI Team,
and all of the staff who took care of
me, I wouldn’t be here,” he adds.
“Words cannot describe how I feel.”
If you or someone you are with experiences these symptoms and you are not
sure what is wrong, call 9-1-1.
Medical Center
at Ithaca 15
16 WINTER 2013 / Health Visions
Still Cookin’!
ristof Ostlund is an Ithaca
luminary among people with a
penchant for Mexican and southwestern cuisine. He was the chefowner of the enormously popular
restaurant Coyote Loco from
1991 to 2003, and over the past
twenty-four years the breakfast burritos from
Solaz, his popular vendor stand at the Ithaca
stlund’s painful journey began in July 2008, right after the Grass
Roots Festival where for seventeen years his booth has drawn long
lines of hungry festival-goers. A makeshift ramp at the back of his
pickup truck didn’t hold and he landed hard on his left foot, twisting it and badly breaking both bones in his lower leg just above the
ankle. Orthopedic surgeon Dr. Stephanie Roach surgically repaired
the breaks with a six-inch plate on the outside bone (the fibula) and
two long screws in the inner bone (the tibia).
Ostlund, who was also cooking for a Cornell sorority at the time,
got around on a turning leg caddy, which is a fancy scooter designed
to keep his weight off the lower part of his injured leg. However,
three months later an X-ray revealed there was insufficient bone
growth to heal the break in the fibula. He switched to a walking boot
cast, and for the next forty days he used a magnetic bone-growth
stimulator. Ostlund says it was a long, hard haul. The bones eventually knit together but the muscles in his leg had atrophied. Physical
therapy, along with weight training at Island Health and Fitness,
helped strengthen his muscles, but even with special support hose
his lower leg and foot remained very swollen. This condition, called
lymphedema, can develop following a traumatic injury when lymph
fluid cannot flow freely though the affected limb due to scar tissue.
Seven months after the initial breaks, Ostlund went to see Dr.
Guillermo Ferrer, who is a board-certified general surgeon with fellowship training in vascular and thoracic surgery. Ferrer specializes
in treating lymphedema and vein disorders, including venous stasis
Farmers Market, have become
legendary. At 6’5”, Ostlund towers
over his Solaz helpers at the Saturday market. These days his regular
customers are happy to spot his
lanky frame standing up at the grill
once again after four long years of
having to cook sitting down due to an injury that
just wouldn’t heal.
ulcers. These painful wounds are caused by venous hypertension,
a condition in which blood flow in the legs is impaired. “Dr. Ferrer
explained the problems I was having with my circulation and my
lymph system and the possibility of complications should I develop
an infection,” says Ostlund. “He gave me a pneumatic boot to wear to
increase the circulation in my left leg. I used it for about six months.”
One morning, eighteen months after the accident, Ostlund
noticed a tiny scab on the outside of his foot. “I didn’t remember
cutting my foot so I couldn’t figure out where that little scab came
from,” Ostlund recalls. A visit to his primary care physician, Dr.
Lloyd Darlow, provided the answer: that tiny spot was the onset of
an ulcer and proved to be the beginning of a whole new set of very
difficult problems.
When time doesn’t heal all wounds
In the body’s circulatory system, the arteries carry oxygenated blood
to the tissues and the veins carry the oxygen-depleted blood back to
the heart and lungs. As the blood travels up the leg and back to the
heart, a series of little valves in the leg veins open and close to help
move the blood upward. A second, very important network of vessels
and nodes called the lymph system works in tandem with the circulatory system to fight infection and promote healing. The microscopic lymph vessels carry fluid made up of molecules of protein, water,
fats, and waste, along with cells that attack bacteria in the blood.
Lymphatic fluid ultimately drains into the central venous circulation. 17
“The wound was not going away, it hurt
like crazy, and I was freaking out.”
“Kristof was born with venous insufficiency,
Dr. Guillermo Ferrer
Tammy Molitis, LPN, and Dr. Cora Foster,
director of the Cayuga Center for Wound
Healing with the hyperbaric chamber.
18 WINTER 2013 / Health Visions
which is the inadequate return of blood to the
heart from peripheral veins in the legs and
arms, usually due to an inefficient venous valvular system,” Ferrer explains. ”This underlying condition made it difficult for him to heal
following the trauma to his leg. As a result, the
tissue became more and more fragile, which
contributed to the breakdown of his skin and
the creation of ulcers.
“The soft tissue damage at the level of
the ankle compounded his problem,” Ferrer
continues. “We have lymph nodes stationed
throughout the body, especially at the joints.
The ankle is narrow so trauma there can
produce chronic swelling, or lymphedema,
and this makes the tissue prone to
infection. It is a vicious cycle.”
In 2010 Ostlund’s ulcer began to
grow due to the compromised blood
circulation in the veins of his leg,
and he was referred to the Cayuga
Center for Wound Healing. “The ulcer
became the size of a half-dollar coin,”
Ostlund remembers. “They put me
in a special four-layer compressive
wrap and over time the ulcer started
to shrink.” Then Ostlund worked a
hectic four-day weekend at the Grass
Roots Festival. “It was the year of
the horizontal rain and I got thoroughly soaked,” he says. “A couple
of days into the event I felt an ulcer
developing on the other side of my foot. I now
had one ulcer that was healing on the outside
of my foot and another one that was growing on the inside of my foot. The new ulcer
grew to nearly three inches long and three-
sixteenths of an inch deep.”
The pain intensified and Ostlund developed an infection. Over the course of a
year, the ulcer grew worse, then better, and
then worse. “Each time the ulcer became infected, the overall tissue damage increased,
making the tissue more prone to breakdown
and infection to the point where the ulcer
would not heal at all,” says Ferrer.
“At various periods I was in the wound
clinic as often as three times a week,”
says Ostlund. “The people taking care of
me there were very experienced and the
bandaging went smoothly.” But in February
2011, Ostlund developed yet another infection, this time on the bottom of his foot.
“My foot became very painful and red,” he
recalls. “I called Dr. Ferrer and described my
symptoms to him over the phone. He told
me to go directly to the Emergency Department at Cayuga Medical Center. I ended up
being infused with IV antibiotics twice a day
for two weeks.
“The wound was not going away, it hurt
like crazy, and I was freaking out,” says
Ostlund. “The pain made it difficult to get
through the day. After cooking all day, I’d
sometimes go up to the bedroom, stick a
pillow over my head, and just scream. But
through it all the doctors and nurses in the
wound clinic helped me keep my spirits up.”
The impact of oxygen
In September 2011 Cayuga Medical Center
introduced hyperbaric medicine to Tompkins County. Ostlund’s chronically infected
wound made him a candidate for this
“Hyperbaric therapy is based on a relatively simple principle,” Ferrer explains.
“If we can provide more oxygen to tissues,
they will heal. The patient is not only
breathing 100 percent oxygen while in the
hyperbaric chamber, but this happens in
a pressurized atmosphere. The deeper the
pressure, the more oxygen enters the tissue that has been starving for oxygen.
It enters the tissue through the lungs
and also passes directly into the tissue
from the outside, entering every single
cell of the body. Hyperoxygenation with
intermittent periods of rest allows healing
to occur.”
Following a new round of antibiotics,
Ostlund took his first “dive” in the hyperbaric chamber. “The first time I went
into the tank I was really nervous,” says
Ostlund. “I was nervous because I was
afraid it wouldn’t work or that I wouldn’t
be able to do it; I had tried skin diving
before and my ears couldn’t take the
pressure. But mostly I thought: if I can’t
undergo this therapy to heal this wound,
what am I going to do? I was scared.”
“Kristof is predisposed to this problem so it doesn’t take much for ulcers to
develop,” explains Ferrer. “Ulcers can
happen spontaneously or develop from
a minor specific event, such as a bump,
an insect bite, or improperly fitting
shoes. We used every approach to help
him heal—pneumatic devices, compression bandages, compression stockings—
to no avail. We performed a graft of
bioengineered skin but this did not work
either. Since his tissue had such poor
oxygenation, our last available option
was to hyperoxygenate the tissue, which
we were able to do with the introduction
of hyperbaric wound therapy at Cayuga
Medical Center.”
Over a period of two and a half
months, Ostlund had a total of forty-five
sessions in the hyperbaric chamber,
“It’s wonderful to have this tool available now to heal wounds that in the past could basically be lifelong problems, and
it is very important that people know we have this therapy available locally to promote healing.” Guillermo Ferrer, MD
ranging from two to five sessions a
week in the beginning. Ear, nose, and
throat specialist Dr. Rob Strominger put
tubes in Ostlund’s ears so he could be
comfortable in an environment that was
equivalent to 2.5 atmospheres or fiftyfive feet deep under water. Each therapy
session took nearly three hours. “Having
this service available locally was a huge,
huge help,” says Ostlund. “Given how
long the sessions take, traveling out of
town for this therapy would have meant
I’d be out of work until I healed.
“I watched the wound get smaller
and smaller,” Ostlund continues. “The
infection disappeared and I was discharged in January 2012. It took two years
to heal this last ulcer; I celebrated two
birthdays with my nurses in the wound
clinic. They were very, very compassionate,” he adds. “I was hurting and scared
and there were times when I was difficult
but they never got upset.”
“Kristof is now healed, but he is also
aware that this problem can recur given his
predisposition,” says Ferrer. “I think it’s
wonderful to have this tool available now to
heal wounds that in the past could basically
be lifelong problems, and it is very important that people know we have this therapy
available locally to promote healing.”
“You have to maintain your sense of
humor to keep your sanity,” says Ostlund
smiling. “I am finally healed up and back
to wearing regular shoes and support hose
with heavy compression. I am now fully
sympathetic with the plight of women when
they have a run in their stockings. And
because I cannot afford to break my leg
again, they’ll be no more hang-gliding for
me!” That’s fine with the many people who
appreciate Kristof Ostlund’s cooking.
Medical Center
at Ithaca 19
N av i g at i n g t
sara taylor
20 WINTER 2013 / Health Visions
a lt h -
Elyse Putorti, ATC,
Patient Navigator
- Care System
Sara Taylor is a very busy wife and mom,
with two young sons ages nine and three. She had been
experiencing a slowly progressive knee problem when a Zumba
class in March 2012 put the finishing touch on what turned out to be a torn
meniscus. A trip to the Urgent Care Center on Arrowwood Drive in Ithaca confirmed the diagnosis, and before she left she had been given the phone number of
Cayuga Medical Center’s orthopedic patient navigator.
“I called the number and the
patient navigator called me
back within five minutes,” says
Taylor. “She made an appointment for me two days later at
Dr. Mannino’s office [Orthopedic
Services of Cayuga Medical
Associates]. My family and I
were going out of town so Dr.
Mannino added me to his operating schedule four days later
so we could still make the trip.
The patient navigator called me
the day after surgery to check in
and see how I was doing.”
After surgery to repair her
injured knee Taylor began physical therapy with Margaret Vence,
DPT, Cayuga Medical Center’s
director of Orthopedics and
Sports Medicine. Taylor is
concentrating on Pilates and
yoga these days to stay in shape
and says she is happy she had
the surgery.
“The patient navigator service is wonderful, convenient,
easy, and accommodating,”
says Taylor, “especially in
comparison to other scheduling
experiences I’ve had. And the
care I received was excellent—
on a scale of one to ten it was
definitely a ten!”
Help is just a phone
call away
“Patient navigation is really
about helping patients find their
way around a complex healthcare system,” explains John
Rudd, Cayuga Medical Center
president and CEO. “If you are
someone with a cancer diagnosis or an orthopedic injury, there
are typically several different
care providers involved in your
treatment. Having someone who
can guide you through all the
different aspects of care makes
for a much more focused and
positive patient experience.”
Cayuga Medical Center now employs three patient navigators
whose jobs are to help patients
understand their specific illness
or injury and to help them gain
easy access to the services they
need in a timely fashion.
Elyse Putorti, ATC, is a certified
athletic trainer and the ortho-
pedic patient navigator. She
helps patients like Sara Taylor
with orthopedic problems and
sports-related injuries. Putorti’s
athletic training at Ithaca College enables her to ask the right
questions over the phone to
determine if the patient needs to
be seen immediately or whether
an appointment within the next
twenty-four to forty-eight hours
is soon enough. She also oversees the Joint Solutions Program
for patients undergoing hip and
knee replacement surgery. “My
main job is to talk with patients
who have orthopedic concerns
and questions. The person I
am talking to on the phone has
my undivided attention,” says
“Essentially I have two
roles,” she continues. “One is
to help patients get in to see the
appropriate care provider as
quickly as possible and to advise
patients on self-care until they
see the doctor. My other role is to
assist primary-care doctors and
urgent-care doctors with referrals for patients with orthopedic
and sports-related injuries. As
the liaison between the patient
and the care providers, I help coordinate care for each patient.”
Additionally she helps patients
understand the referral process
to satisfy the requirements of
their health insurance policies.
Putorti emphasizes that callers will reach her directly unless
she is on the phone helping another patient. During the phone
call she will ask about your
injury and she will not conclude
the phone call until you have an
appointment with a doctor. You
will not be transferred; rather,
you will stay on the line together
until the appointment is established.
“Patient feedback indicates
we’re getting great results,” says
Putorti. “I monitor our orthopedic, sports medicine, and
physical therapy services and I
share feedback with the practice
managers. Patients who have
previously traveled out of town
for care tell us they’ve never had
this kind of clear explanation
and diagnostic help before.” 21
john powell, MD
Betty Mc Ever, RN
A ho listic approach to ca n ce r car e
Meet John Powell, MD, Radiation Oncologist
Dr. John Powell is the newest member of the cancer care
team at the Cayuga Cancer Center. He earned his undergraduate degree in biology from Cornell University and
went on to medical school at Upstate Medical University
in Syracuse, where he was inducted into the Alpha Omega
Alpha Medical Honor Society. He completed his radiation
oncology residency at Upstate University Hospital. Dr. Powell
returns to Ithaca from North Carolina, where he had been a
radiation oncologist at Carteret General Hospital in Morehead
City. While there he served as chairman of the Cancer Committee and chairman of the Department of Clinical Support, and
was a member of the Medical Executive Committee.
Navigating C ancer C are
ayuga Medical Center is accredited with commendation as
a Community Hospital Comprehensive Cancer Program by the
American College of Surgeons’
Commission on Cancer.
n Radiation therapy is provided in a state-of-the-art facility
located adjacent to the medical
center. This service is offered in
collaboration with the Roswell
Park Cancer Institute.
n Patients have access to
complete cancer testing and
diagnostic services through the
close collaboration of Imaging
Services, Surgical Services,
and Laboratory.
n Oncology nurse navigation services help patients and
families find their way through
diagnosis and treatment with
personal attention, education
about the specific cancer they
have been diagnosed with, and
an abundance of information
about local support services.
n Three board-certified medical
oncologists work closely with
patients and families to plan
cancer treatment based on the
latest protocols.
22 WINTER 2013 / Health Visions
ew life events elicit the
levels of fear and uncertainty
that come with a cancer diagnosis. Coupled with this anxiety
is a lack of understanding
about what the specific diagnosis means, what the treatment
choices are (and their likely
side effects), and what resources
are available to help patients
and families through this difficult journey.
Betty McEver, RN, BSN, OCN,
CRN, brings over thirty years of
nursing experience to her job
as oncology nurse navigator.
Her list of special certifications
includes oncology nursing,
radiology nursing, and oncology
nurse navigation. “Everyone’s
story is different, their cancer
is different, and their needs are
different,” says McEver, whom
everyone calls Nurse Betty.
“My job is to listen reflectively
to patients, to educate them
about their illness, and to help
them determine their own best
options. Then I act as a liaison
between each patient and his
or her doctors and the various
medical center departments
involved in their care.” She also
helps patients connect with
community resources providing assistance with everything
from transportation to wigs
for hair loss.
“The care of each patient is
unique to that person,” McEver
continues. “This is what we
mean when we say �The Center
Is You.’ Our whole focus here is
patient-centered care.”
Tompkins and the counties
that surround it are home to a
diverse population and cancer
is an equal opportunity illness.
“We bring as much cultural
awareness as we possibly can
to our care,” McEver points out.
“We also work with patients
with various disabilities and
mental health issues. Many patients facing a cancer diagnosis
have what we call co-morbidities
or co-existing medical conditions, such as diabetes or liver
disease. All of these factors
influence their individual cancer
One particular aspect of care
McEver spends time educating
patients and families about is
palliative care. “I want to introduce the concept of it earlier in
their care,” she explains. “Palliative care is a multidisciplinary
approach to relieve suffering. It’s
not just about terminal care—it’s
about quality of life.” Many patients who are in the process of
curative cancer treatment seek
palliative care to help them cope
more comfortably with difficult
side effects.
McEver says she regards people holistically because she is
best able to help them that way.
“I consider their environment
Health and Human Performance
“Patient navigation is really about helping patients find their way around a complex
health-care system.”
john rudd
and their health in body, mind, and
spirit. Being a nurse is not just about
medicine; it’s about promoting health
to improve the quality of a person’s
life. Sometimes quality of life can be
a higher priority than longevity,” she
adds. “Although a cancer diagnosis
can be the worst thing ever, sometimes a cancer diagnosis can change a
person’s life in positive ways. People
often quit smoking, learn to manage
their stress, and begin to make time
for exercise, meditation, and prayer.
You can gain a whole new perspective
on life.
“We hear a lot of positive feedback
from patients,” says McEver. “They
write and call to thank us for taking
the extra time and for making the
effort to help them. We’ve had good
success in removing barriers to care
for patients and that can make all
the difference in their treatment and
follow-up care.”
If you need help navigating your
orthopedic care or the complexities
of a cancer diagnosis, call one of
our patient navigators. They will
advocate for you and help you find
your way.
Medical Center
at Ithaca
Contact information:
Elyse Putorti, ATC, orthopedic and
sports medicine patient navigator:
(607) 252-3510
Betty McEver, RN, BSN, OCN, CRN,
oncology nurse navigator:
(607) 274-4046
risten Verrill, PT, has been appointed to the position of director of
Health and Human Performance at Cayuga Medical Center. In her new role
she will oversee the departments of Physical Therapy, Orthopedics and
Sports Medicine, and Athletic Performance, working closely with Margaret
Vence, DPT, director of Orthopedics and Sports Medicine, and Brian Lee,
PT, OCS, CSCS, director of Physical Therapy. She will continue as director of the Cayuga Center for Healthy Living (CCHL) and will also act as the
liaison to both Island Health and Fitness (IH&F) and Rasa Spa, which are
collaborative partners with Cayuga Medical Center.
“We have such a rich menu of services designed to help people reach
their wellness goals, recover from injuries, and establish healthy lifestyles,” says Verrill. “Each person who comes to us for help has unique
needs. Our goal is to assist them in living the healthiest lives they can by
accessing the services they are looking for.
“If you are trying to reduce the stress in your life, you may want to
consider taking the stress management class at CCHL, getting regular massage at Rasa Spa, and joining an exercise class at IH&F,” Verrill explains.
“Or if you are recovering from an injury, you might want to augment your
physical therapy with water aerobics at IH&F in the warm water pool. We
also offer classes at CCHL and IH&F to meet the special needs of patients
before and after bariatric surgery. People recovering from heart attacks
often transition directly from classes in cardiac rehabilitation and tobacco
cessation to therapeutic yoga at Rasa Spa and to memberships at IH&F so
they can maintain the gains they’ve made in their recovery process.”
In the past decade Cayuga Medical Center has introduced many new
programs and classes specifically for people who want to become as
healthy as they can. “Nowhere else in the region will you find what we
are offering all in one building,” says Verrill, referring to the Island Health
Center. “This is all part of Cayuga Medical Center’s focus on improving the
health of our community.
“If you have healthy lifestyle goals for the new year, check out the
menu of services at Island Health and Fitness, Rasa Spa, and Cayuga
Medical Center—and get in touch,” says Verrill. “We want to be your partners in good health!”
Medical Center
at Ithaca 23
Bringing It All Together
Cl i n i c a l I n t e g r a t i o n
higher price tag for goods and services often
means higher quality. This is not always the case,
however, when it comes to health care. For more than
two decades experts working with the Dartmouth Atlas
of Health Care have studied Medicare billing records
and discovered huge variations in treatment and
spending between communities. Some communities
spend three times as much as others with no better
results, due to unnecessary tests, procedures, and
services. More expensive health care is not necessarily
better health care, and it may actually be more inefficient. Sadly, the problem worsens exponentially for
the sickest among us.
In the last decade alone the cost of employer health
insurance premiums and employee contributions
to their health-care plans have more than doubled.
Local health-care providers have dedicated themselves
to reversing this trend in our community. The Cayuga
Area Plan (CAP) is a partnership that includes Cayuga
Medical Center and the Cayuga Area Physicians
Alliance (CAPa), a network of local providers. CAP
has been working diligently to craft a system that will
improve the quality and efficiency of patient care. Care
that is better managed will have the additional value
of holding costs in check.
The Clinical Integration (CI) Program offered through
CAP is now up and running in our community. The primary
goals of clinical integration are to improve clinical quality
and patient outcomes, improve the care of high-risk
patients, and reduce the overall cost of care.
Clinical integration is a local health-care system
that promotes a high degree of interdependence and
cooperation among participating physicians. Using
advanced information technology, doctors in a clinically integrated system can efficiently share data on
patients and improve the delivery of health care. This
cooperation minimizes duplicate diagnostic testing
24 WINTER 2013 / Health Visions
and provides an avenue for real-time consultation
among members of a patient’s care team. “Interaction
between doctors and offices will be smooth and fast
and well worth the price of implementation,” says
Lloyd Darlow, MD, vice president for clinical integration at Cayuga Medical Center.
“We are focusing on the value of the care provided
to patients rather than the volume of care,” points out
John Rudd, president and
CEO of Cayuga Medical
Center. “We believe we can
improve both quality and
efficiency without sacrificing one for the other. What
makes our program different,” he adds, ”is that our
model includes both hospital-employed and independent physician practices. We believe it is important
to work in collaboration with our independent physicians to make improvements.”
“This has been a monumental, multiyear undertaking with many interconnected components,” says
Darlow. “It has required a significant commitment of
time, financial resources, and good will on the part of
Improve Physical Health
Fiscal Health
The Three Major Functional Components of Clinical Integration
Physician clinical metrics for every medical specialty
This means that doctors agree to be assessed on how they manage the care of their patients. They
agree on the standards of care by which they will be evaluated, and they receive real-time feedback
on how they are doing.
Coordination of the care of the sickest patients in our community
This is accomplished through a program of care management administered by local doctors and
nurses. Local care management is critically important because it provides a higher level of service
to the people who need it most, and by helping the sickest among us manage and coordinate their
care, it holds costs in check.
Development of electronic health records
This incorporates electronic medical records and health insurance data to provide a perspective
across multiple care providers’ locations. This data is assembled in collaboration with ActiveHealth,
a nationally recognized health-care information company. By working with the health insurance
statistics of local employers, CAP physicians can review data from all of a particular patient’s care
providers to make sure the person is receiving care in a holistic way. 25
Let’s use asthma as an example to illustrate the
difference clinical integration can make.
scenario #1
A scenario in a system without clinical integration
Our hypothetical patient is a fifty-five-year-old woman
needs to pay a coworker overtime to cover for her.
with asthma. For some reason, her asthma has been
growing steadily worse over the past two years. She has
specialist, who prescribes a new medication. Without
seen her primary care physician, who has prescribed
clinical integration, the primary care doctor may not know
medication and an inhaler and asked the patient to come
about the Emergency Department visits or the hospitaliza-
back for a checkup in two months.
tion. The asthma specialist and primary care doctor
may not be in direct contact with each other to consult on
During those two months the patient makes two trips
The patient makes an appointment to see an asthma
to the Emergency Department in respiratory distress.
medication and the best course of treatment. The care is
The second trip results in an overnight hospitalization.
fragmented, the patient doesn’t feel well, she is missing
She has a pulmonary function test that determines her
work, and her employer’s health insurance provider is
lung function is impaired.
paying for care that might have been avoidable in a more
integrated system.
Over a six-month period she misses several days of
work during an especially busy season and her employer
scenario #2
The same scenario in a clinically integrated system
Because our asthma patient is seeing her doctors
caregivers manage her asthma.
more frequently than usual and is making multiple trips
With more regular care and proactive support, the
to the hospital, she is identified as a high-risk patient
patient is able to identify when and why she is feeling
and is assigned a care manager. The care manager is a
worse and works to rectify the situation. She does not ex-
nurse who works very closely with the patient and the
perience as many acute episodes that require emergency
patient’s doctors to help coordinate her care more pro-
intervention and hospitalization. The patient, the care
actively and effectively. Through frequent conversations
manager, and the doctors all work to manage her asthma
and e-mails the care manager learns from the patient
risk and move her from the high-risk category to the
that her son, who is a smoker, has moved back into the
moderate- or low-risk category. By receiving a higher
patient’s home, bringing a beloved pet with him. This
quality of coordinated, integrated care she is healthier
is new, critically important information that will help
and she is using fewer health care resources.
26 WINTER 2013 / Health Visions
Cayuga Medical Center and the members of
the Cayuga Area Physicians Alliance, which
I am proud to say includes the vast majority
of physicians practicing here.”
Clinical integration: the good
news in health care
Martin Stallone, MD, MBA, director of hospitalist medicine at Cayuga Medical Center,
serves as the medical director of the CAP
Clinical Integration Program. “A television
special on PBS
entitled �U.S.
Health Care:
The Good News
in American
Medicine’ aired
in February
2012. It profiled
different communities across the country
and talked about the most successful, innovative community health initiatives in
the nation,” says Stallone. “We’re doing as
much as, if not more than, the communities
featured in the special.”
Clinical integration is in many ways a
simple concept, but its execution requires
close collaboration and commitment.
“Using the platform of CAP, which has
been in place for fifteen years, independent
physicians, hospital-employed physicians,
and the medical center can come together
in an atmosphere of trust and respect. This
kind of collaboration just doesn’t happen in
most communities,” observes Travis Turner,
executive director of CAP. “As the CI Program
moves forward,
we can provide
real value to
employers and
health care to
the residents of
our community.”
How does it all work
“Every time a health insurance card is
presented at the doctor’s office, at the
hospital, or at the drugstore and a claim
is generated, this data flows into our
system,” says Darlow. “ActiveHealth collects the claims data and feeds it to our
program administrators. We can use it
to help improve care while holding costs
in check. There are very few clinically
integrated systems like this in the country.
However, these networks have shown
that they have healthier patients and an
improved bottom line for participating
businesses because they have healthier
employees. As our clinically integrated
network progresses, we will have the
data showing how we have been able
to improve care for members of our
Darlow continues, “Because health
insurance companies pay the medical
claims, they can provide doctors and care
managers in the local health-care system
with the data necessary to group local patients into low-, moderate-, and high-risk
classifications. The people in the highest
risk category are the ones who require
the most health care, use the Emergency
Department most often, and have the
most hospital admissions and readmissions. If we can help this group of
patients become healthier through better
management of their health problems,
we can improve their medical care and
keep costs down at the same time.”
they are in the high-risk category. I can now
identify those people and work with the CAP
care manager to help them maintain better
control of their asthma and feel better. And
with fewer serious episodes, their health
care costs decline.
“Clinical integration has broad, sweeping implications and has the potential
to affect the entire community in many
positive ways,” says Darlow. “Healthier
employees mean increased productivity
for businesses. Keeping health care local
strengthens the entire community, as well.
Patient safety increases, communication
among physicians improves, and confidence in our entire health care system
rises. This becomes a place sought out by
patients and new physicians for the excellence of care. It’s important to understand
that clinical integration does not ration
or put up roadblocks to care,” he adds.
“We believe we can utilize our resources
here as well as or better than any network
in the state. The goal here is optimization
of health care resources through collaboration and greater efficiency.”
John Rudd and his many colleagues
on the medical staff and the medical
center’s administrative team are excited
about the possibilities the CAP CI Program
offers. “Clinical integration is what’s best
for our community, and it makes sense
regardless of where we end up with healthcare reform,” he says. “It’s about higher
quality and more affordable health care.
After all, that’s why we’re here.”
Medical Center
at Ithaca
The Bottom Line
Cayuga Medical Center is the first local
employer to sign up for the CAP CI
Program. “Using the CI Program, I can
take a look at all of my patients who
work at Cayuga Medical Center who have
asthma,” Darlow explains. “It may be that
out of all of those patients, there are three
whose asthma is not well controlled and 27
Cayuga Heart Institute
Continues High Standards
The Cayuga Heart Institute has achieved reaccreditation for adult transthoracic and transesophageal echocardiography services, which
are critical components of diagnostic cardiac
care. Meeting the high standards of accreditation is a major accomplishment, and consistently
maintaining those standards for reaccreditation
requires a focused team effort. In addition to
raising the bar for local cardiac care, Cayuga
Medical Center’s affiliation with the nationally
renowned Sands-Constellation Heart Institute at
Rochester General Hospital ensures seamless
access to care for local cardiac patients requiring
open-heart surgery and other interventional
Upcoming Silver Service Lectures
All Silver Service lectures are free and open to
the public. They are presented at 2:00 p.m. in the
DeWitt Clinton Auditorium at Kendal at Ithaca.
February 15
Paul Stefek, MD, Interventional Cardiologist
Cayuga Heart Institute at Cayuga Medical Center
“Know Your Numbers”
March 8
Steven Rogers, MD
Gastroenterology Associates of Ithaca
“Do I Have Acid Reflux?”
April 12
Andrew M. Jordan, PT, DPT, OCS
Department of Physical Therapy,
Cayuga Medical Center
“The Aging Shoulder: A User’s Guide”
May 10
Douglas MacQueen, MD, Infectious Disease
Cayuga Medical Associates of Ithaca
“HIV Update”
June 14
Amy MacQueen, MD
Cayuga Medical Center Sports Medicine and
Athletic Performance
“Treating the Pain of Osteoarthritis”
July 12
Eleanor Liebson, Occupational Therapist
Department of Physical Therapy,
Cayuga Medical Center
“Therapeutic Yoga for All Ages”
28 WINTER 2013 / Health Visions
procedures not performed locally. The
Sands-Constellation Heart Institute was
recently ranked number one for cardiac
care in New York State.
Local Physician Recognized
On National Philanthropy Day, Cayuga
Medical Center medical staff member
Dr. Ann Costello was honored as Volunteer
Fundraiser of the Year. “Women Swimmin’
for Hospicare” began nine years ago as the
result of a conversation between Dr. Costello
and Cornell professor emerita Joan Jacobs
Brumberg. Since its inception this annual
event has raised over $2 million, with
Dr. Costello recognized as a top fundraiser
every year. We join the community in
expressing our gratitude to Dr. Costello for
her inspiring leadership and her commitment to the availability of outstanding
hospice and palliative care services right
here in Tompkins County.
Imaging Services Earns
The American College of Radiology (ACR)
has once again accredited the Department
of Imaging Services for all five CT (computed
tomography) scanning systems at Cayuga
Medical Center and its Convenient Care Centers
in Ithaca and Cortland. This accreditation
means that our imaging department meets
or exceeds ACR’s high performance standards
for diagnostic and interventional CT scans.
Our maternal-child care experts offer
monthly workshops to the public on a variety
of important topics. Call (607) 274-4408 for
information and to register. Fees are $15–25
per family unless otherwise indicated.
Expectant Parent Workshops: Daylong
program. Fee $75 per family.
Siblings Are Special: For children ages
3–8 years who are about to become big
brothers and sisters.
Breastfeeding Plan for Success: For new
and experienced moms and their partners.
Infant Care and Safety Class: The basics of
care, feeding, and safety of your baby in the
first few weeks.
If you are looking for help in making
medically necessary lifestyle changes,
check out the Center for Healthy Living
(CCHL) at the Island Health Center.
Classes at CCHL include:
Cardiovascular Disease Prevention & Cardiac
Rehabilitation: To help people with cardiacrelated medical conditions learn strategies
to improve these conditions. This program
includes supervised exercise, dietary counseling, stress management, and education about
your disease and its medical management.
Medically Supervised Exercise (MSE):
Exercise guidance for people who have
difficulty being active due to chronic medical
Aquatic Medically Supervised Exercise:
To improve strength, flexibility, balance, and
cardiovascular endurance in the buoyancy
of water. The program will also assist you in
developing your own independent aquatic
exercise routine. Swimming experience is not
OptifastВ® Weight-Loss Program: A twelveweek meal-replacement program that combines weekly clinician visits, ongoing education, and support to help participants achieve
and maintain long-term weight loss. If you are
serious about losing weight, don’t wait!
Healthy Living 101: To learn basic principles
of lifestyle management for disease prevention, and to help control type 2 diabetes.
Tobacco Cessation: To help you quit your
habit. Tobacco cessation support groups are
offered on a monthly basis for anyone who
is thinking about quitting, is ready to quit, or
is trying to maintain being tobacco free. Join
in, no matter where you are on your quitting
Healthy Living with Type 2 Diabetes: To
learn to use the principles of lifestyle management to help control type 2 diabetes.
Call (607) 252-3590 for CCHL class dates,
information, and fees.
Diabetes Education Classes: To learn and
practice the skills you need to manage
House Calls
Reconstructive Surgery Following Mastectomy
David Monacelli, MD
Dr. David Monacelli is a board-certified
plastic surgeon on the medical staff of
Cayuga Medical Center. He completed his
plastic surgery residency at Yale University and has extensive experience in both
reconstructive and cosmetic procedures
of the breast. In this issue of Health
Visions Dr. Monacelli provides our
readers with a brief overview of breast
reconstruction following a mastectomy.
For more in-depth information or for
a consultation, he can be reached at
(607) 266-0483.
Q: What is a mastectomy?
A: A mastectomy is the surgical removal of
the breast, including all of the breast tissue,
typically the nipple and areola, and various
amounts of skin. This surgery is performed
to treat breast cancer, and in certain highrisk patients it may be performed to prevent
breast cancer.
Q: Is breast reconstruction after
mastectomy common?
A: In the recent study of a national database of patients undergoing total mastectomy between 1998 and 2008, researchers
confirmed that more women are now
choosing immediate breast reconstruction
following total mastectomy. While historically only 25 percent of women opted for
immediate breast reconstruction, today
that figure is 38 percent.
Q: At what point should a woman with a breast-cancer diagnosis consult with a plastic surgeon?
A: I recommend that patients considering
breast surgery to treat cancer see me as
soon as possible. If you and your general
surgeon are deciding between a lumpectomy and a mastectomy, consultation with
an experienced plastic surgeon can help
you determine what feels right for you. The
decision to have breast reconstruction is
extremely personal. You have to decide if
the benefits will achieve your goals and if
the risks and potential complications are
acceptable. A plastic surgeon can help you
in this process.
Q: Are there different choices to
be made regarding breast recon-
A: Yes, there are different surgical procedures and timelines to consider. Some
women choose immediate breast reconstruction following mastectomy, while
others choose to delay reconstruction.
In my experience, patients who undergo
immediate reconstruction are usually
happiest with the results. There are also
different surgical approaches to breast
reconstruction. The two most common
techniques for reconstructing a new breast
mound are implant reconstruction and
TRAM-flap reconstruction.
Q: What are the pros and cons of implant reconstruction?
A: The major advantage of implant
reconstruction is that it is a simpler
surgery than TRAM-flap reconstruction and
patients recover more easily. One of the
drawbacks of implant reconstruction is that
it requires several office visits over time, as
the skin and chest muscle are expanded to
create space for the final implant. Another
consideration is that in many cases additional revisions may be necessary over
time to correct implants that have ruptured,
leaked, or become wrinkled. Saline and
silicone implants are both available for
Q: What are the pros and cons of TRAM-flap surgery?
A: TRAM-flap surgery uses a woman’s own
skin, fat, and muscle from the abdomen to
reconstruct the breast. The advantages are
that the breast mound is made of natural
living tissue and once the reconstruction is
done, additional revisions are uncommon.
The drawbacks are that this is a much bigger
surgical procedure than implant reconstruction and patients take longer to recover.
Additionally, women who smoke or who
have diabetes or high blood pressure are
not good candidates for TRAM-flap surgery
because these complications adversely
affect blood flow and healing.
Q: Which type of breast reconstruc-
tion is most common today?
A: When I established my practice here
nineteen years ago, I introduced TRAM-flap
reconstruction to the area. This was the
preferred method of reconstruction at
that time. However, today more women
are choosing implant reconstruction over
TRAM-flap surgery due, in part, to multiple
advances in implant reconstructive surgery
over the years and the rerelease of silicone
gel implants by the FDA for general use. We
now have very good evidence that the silicone implants in use today are quite safe.
Seeing patients evenings and weekends
To better meet the needs of our community, we offer after-hours outpatient pediatric and
adolescent care (infant to 17 years old) in a clinic setting. Kids Care is staffed by our local
pediatricians from Buttermilk Falls Pediatrics and Northeast Pediatrics and Adolescent Medicine,
and by registered nurses who are experienced in the care of sick babies and children.
When to go to
Walk-in facility for minor illness or injury, such as:
•Virus and flu symptoms
•Vomiting, nausea, diarrhea, abdominal pain
•Sore throat, cough, difficulty breathing
•Ear and eye problems
•Head injury
•Falls and minor injuries
•Skin complaints
•Sprains and strains
•Puncture wounds and animal bites
•Possible allergic reactions
•Tick bite
Kids Care hours
Monday – Friday
5:00 p.m. to 9:00 p.m.
Noon to 6:00 p.m.
10:00 a.m. to 6:00 p.m.
Kids Care
Pediatric Services
Cayuga Medical Center
101 Dates Drive
Ithaca, New York 14850
From the Cayuga Medical Center main lobby or 1st floor
visitor lobby, follow signs and take elevator to the 3rd floor.
All other serious medical emergencies, go to
the nearest Emergency Department or dial 911.